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Oral Nutritional Supplements and Appetite Stimulation Therapy
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
Among the many agents in the class of antihistamines, cyproheptadine is the most well studied for appetite stimulation (Silverstone and Schuyler 1975). Cyproheptadine has both antihistamine and anticholinergic effects. It has been safely utilized for appetite stimulation in pediatric patients (Sant’Anna et al. 2014). Cyproheptadine has also been used for weight loss in cancer and anorexia nervosa (Golden et al. 2003).
CBRN and the Trauma Victim
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
The serotonergic toxidrome presents with confusion, agitation or coma, tachycardia, hypertension, hyperthermia, tachypnoea and mydriasis. It can be caused by directly stimulating the relevant receptor (for example, triptans), increasing the release of serotonin (amphetamines, cocaine) or decreasing the re-uptake of serotonin (SSRIs, tricyclic antidepressants, tramadol). Treatment is supportive, including the use of benzodiazepines for agitation and muscular rigidity. Cyproheptadine can be considered in severe cases; liaise with a toxicologist.
Neurotoxicology
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Sean D. McCann, Trevonne M. Thompson
The differentiation between these two entities is of more academic importance than clinical importance, and some overlap may exist in an individual patient's presentation. Treatment for both syndromes is essentially the same: discontinuation of the offending agent and aggressive supportive care. Accurate determination of a core temperature, preferably obtained rectally, is of critical importance. The hyperthermic patient should undergo rapid active cooling (as discussed above). BZD should be liberally administered and titrated to clinical effect, particularly control of tachycardia, neuromuscular symptoms, and hyperthermia. Cyproheptadine and bromocriptine have been described as antidotes for SS and NMS, respectively. The efficacy of these agents is limited, and they are likely only useful in cases of mild toxicity. Both of these drugs have the potential to cloud the clinical situation. Cyproheptadine is an antihistamine that can have anticholinergic properties. Bromocriptine can have serotonergic properties. It is best to avoid these drugs in favor of BZD.
Emerging therapeutic targets for anorexia nervosa
Published in Expert Opinion on Therapeutic Targets, 2023
Since a common side effect of antihistamines, acting on H1, H2 and H3 receptors with the action on the H3 suspected to predominate the effect on body weight, is sedation and/or an increase in body weight, antihistamines have been suggested to be beneficial in the treatment of anorexia nervosa as well. Cyproheptadine, a serotonin and histamine antagonist, was tested in a four-arm randomized controlled trial with the following groups: cyproheptadine and behavioral therapy or cyproheptadine and control therapy, placebo and behavioral therapy or placebo and control therapy. While cyproheptadine had no effect on body weight gain, some effects were observed on body distortion and anorexia-related cognitions [74]. Another trial compared the effect of cyproheptadine against amitriptyline and placebo, and showed that cyproheptadine decreased the length of time to reach the weight gain objective similar to amitriptyline, while it reduced depressiveness significantly more than amitriptyline [75]. Interestingly, one small brain imaging study using positron emission tomography (PET) scan visualizing H1 binding showed increased H1 binding in female patients with anorexia compared to normal females predominantly in the left lenticular nucleus and the right amygdala [76]. Moreover, an inverse association was observed between H1 binding and anxiety and depressiveness [76] pointing toward a neuroanatomical correlate of the antidepressant effect of the antihistaminergic compound reported before. However, these data are not sufficient enough to justify a recommendation for antihistamines in the treatment of anorexia nervosa yet.
Fatal serotonin syndrome: a systematic review of 56 cases in the literature
Published in Clinical Toxicology, 2021
Sanjay Prakash, Chaturbhuj Rathore, Kaushik Rana, Anurag Prakash
Details of treatment were available for 37 (66%) cases. Most of the patients received supportive therapies. Nine patients (16%) received cyproheptadine, with the doses described for six patients. These included 4 mg every 4 h [26], 8 mg followed by 4 mg every 8 h [27], 8 mg every 6 h for 4 d [32], a total dose of 24 mg [33], 12 mg over 5 h [44], and 12 mg once followed by 2 mg every 2 h for 24 h [51]. Benzodiazepines were given in seven patients (midazolam – five patients and diazepam – two patients). The doses of midazolam was described for three patients, a total dose of 8 mg in two patients [11, 26], and 5 mg every hour in one patient. The dose of diazepam was mentioned in one patient (a total dose of 10 mg) [14]. Seven (13%) patients received dantrolene. Fentanyl was administered to two patients.
Monitoring for antidepressant-associated adverse events in the treatment of patients with major depressive disorder: An international consensus statement
Published in The World Journal of Biological Psychiatry, 2018
Seetal Dodd, Philip B. Mitchell, Michael Bauer, Lakshmi Yatham, Allan H. Young, Sidney H. Kennedy, Lana Williams, Trisha Suppes, Carlos Lopez Jaramillo, Madhukar H. Trivedi, Maurizio Fava, A. John Rush, Roger S. McIntyre, Michael E. Thase, Raymond W. Lam, Emanuel Severus, Siegfried Kasper, Michael Berk
Serotonin syndrome is the possible result of excessive serotonin receptor antagonism and not necessarily an idiopathic drug reaction (Boyer and Shannon 2005). Serotonin syndrome is diagnosed by clinical symptoms suggestive of CNS hyper-excitability co-occurring with drug-induced increased serotonin. Symptoms vary between cases and may be mild to life threatening. Common symptoms include; confusion, consciousness impairment, agitation, tremor, hyperreflexia, myoclonus, tachycardia, hypertension and fever. In more severe cases rhabdomyolysis, clonus, rigidity/hypertonicity, elevated temperature, fever or hyperthermia may be evident (Werneke et al. 2016). Treatment of serotonin syndrome requires stopping the serotonergic agent in all cases. Intensity of treatment depends on the severity of illness however, treating clinicians should be aware that some cases may deteriorate without aggressive management. Cardiorespiratory and thermal abnormalities must be aggressively corrected (Boyer and Shannon 2005). Cyproheptadine is a recommended therapy, although other agents have been used (Boyer and Shannon 2005).